Presented by:
Senior Isolation and Loneliness
#TRCCWebSeries
E.A. Casey
Program Manager
Isolation Impact Area
AARP Foundation
Karen Keown
Director of Clinical Program
Healthcare Transformation
UnitedHealth Group Alliances
Shirley Musich
Senior Research Director
Advanced Analytics Group
Optum
An estimated 1 in 5 adults over 50 are affected by isolation, and
research shows that prolonged social isolation can be equivalent
to smoking 15 cigarettes a day.
Social Connectedness
Instrumental
Transportation, food
access, bill paying,
medication adherence
Emotional
Empathy, trust
Social Isolation: when you
objectively lack one or more of
these
Loneliness: when you feel like
Informational
Advice, guidance,
referrals
you lack one or more of these
Understanding Isolation
Subjective Isolation
Objective Isolation
How an individual perceives their
experience and whether or not he/she
feels isolated
A quantifiable status that can be
determined outside an individual’s
perception
Key Concepts:
 Loneliness
 Sense of Purpose
 Feeling of Belonging
Measurement: UCLA Loneliness Scale
– a 20 question instrument that is valid
and reliable
Key Concepts:
 Quality / Quantity of Supportive
Relationships
 Ability to Access Resources and
Information
 Engagement in Social Activities and
Groups
Measurement: e.g. Social Network
Index, Lubben Social Network Scale
Loneliness
3-item Loneliness Scale:
Hardly Ever
Some of the
Time
Often
1. I feel left out
1
2
3
2. I feel isolated
1
2
3
3. I lack companionship
1
2
3
Question
Total the responses; 3 = not lonely, 9 = most lonely
Loneliness
“The pain of loneliness is a biological trigger, like
physical pain or the ache of hunger and thirst. Hunger,
of course, means you need to eat to survive. Pain
sensors protect the individual from physical danger.
Loneliness a warning sign that’s evolved to signal the
need for change in order to restore something
necessary for your survival, probably to do with
protecting the individual from isolation.”
Cacioppo & Hawkley, 2009
Isolation, Loneliness, and Health
• Cardiovascular disease
• Systolic blood pressure
• High blood pressure
• Immune System
• Raised cortisol
• Hormonal & Inflammatory Regulation
• Diminished immunity
• Poor sleep, fatigue, low energy
• Reduced physical activity
• Reduced medical adherence
• Dementia & Cognitive decline
• Higher admissions to nursing homes
• Alzheimer’s disease
• Depression
• High use of emergency services
• Early mortality
Risk Factors
Risk Factor
Individual
Community
Society
Living Alone
●
Physical Disability (e.g. mobility or sensory impairment)
●
●
●
Major Life Transition (e.g. loss of spouse/partner, retirement)
●
●
●
●
Geography (e.g. rural location)
Small Social Network / Inadequate Social Support
●
●
Linguistic and Cultural Barriers
●
●
●
Caregiving Status
●
●
●
Belonging to a Minority Group (e.g. ethnic, racial, LGBT, religious)
●
●
●
●
●
Poor Community Design and/or Resources (e.g., lack of transportation)
Cognitive Impairment (e.g., dementia)
●
●
●
Mental Health Vulnerability (e.g., depression)
●
●
●
A Framework for Understanding
Isolation and Loneliness
Transportation
Challenges
Poor Health
and Well-being
Life Transitions,
Role Loss or
Change
Societal
Barriers
Lack of Access
and Inequality
Most
prevalent
causes of
isolation
Lack of accessible
and affordable
transportation
options
Driving retirement
Untreated hearing
loss
Mobility
impairments
Frailty
Poor mental health
Leaving the
workforce
Loss of a partner
or friends
Becoming a
caregiver
Ageism
Lack of
opportunities for
older adults to
engage and
contribute
Poverty
Rural living
Marginalized
groups
(racial/ethnic
minorities, LGBT,
etc)
Common
responses
that may
prevent or
reduce
isolation
Volunteer-based
ride programs
Livable/agefriendly community
initiatives
Falls prevention
programs
Chronic disease
self-management
Enhance Fitness
Support groups
Lifelong learning
Senior centers
Creative/artful
aging
Intergenerational
programs
Lifelong learning
Policies to support
an older workforce
Resiliency and
empowerment
models
Home-sharing
models
Technology
training
Signs of Isolation
There are no visible “symptoms” of isolation.
You may notice signals such as:
• Pronounced boredom
• Disinterest and withdrawal
• Declining personal hygiene
• Indications of poor eating and nutrition
• Notable home disrepair, clutter or hoarding
The Challenges
Lack of
existing
solutions
and
resources
Highly
subjective
and complex
problem
Lack of
institutional
stakeholders
Lack of
data and
research
Lack of
awareness
and relevant
services
Our Approach
Connect2Affect
Funding opportunity
http://www.aarp.org/aarp-foundation/grants
Contact:
Matt D’Amico, Grant
Program Officer
[email protected]
What else to do?
There is a wide array of ways you can help, some of which you’re probably
already involved in:
•
•
•
•
Talk to the older people in your life and get to know your neighbors
Use technology to facilitate social connection
Measure isolation outcomes
Focus on both challenges and opportunities
Thank you!
E.A. Casey – [email protected]
Presented by:
Questions?
#TRCCWebSeries
The Impact of Loneliness on Quality of Life
and Satisfaction
Contact Information:
Shirley Musich, PhD
Senior Research Director, Advanced Analytics
Optum
315 E. Eisenhower Parkway, Suite 305
Ann Arbor, MI 48108
Email: [email protected]
Phone: 248-626-0082
Shirley Musich, PhD1, Shaohung S. Wang, PhD1, Kevin Hawkins, PhD1, and Charlotte S. Yeh, MD2
1Advanced Analytics, Optum 2AARP Services, Inc.
Objectives
Results
 To estimate the prevalence of loneliness among AARP ® Medicare Supplement insureds who were
eligible for a care coordination (CC) program (i.e., identified through a combination of poor health
status and selected diagnosis codes).
Results (continued)
Characteristics Associated with Severe Loneliness
Prevalence of Loneliness Among AARP Medicare Supplement
Insureds
High health literacy
 To identify characteristics associated with moderate and severe loneliness.
N=3,765 Survey Respondents
Risk Score 3rd quartile
Urban location
28%
Hearing problems
46%
In other research studies regarding loneliness among older adults, loneliness is generally defined as
the discrepancy between a person’s desired and actual social relationships, whether in quality or
quantity.
 Although not unique to old age, loneliness is common among older
adults, with previous studies finding prevalence rates ranging from
25% to 60%.
 Of those with original fee-for-service Medicare coverage (an estimated 34 million Americans), about
27% purchase a Medicare Supplement (i.e. Medigap) plan to defray the out-of-pocket expenses
from co-payments, coinsurance, and deductibles that Medicare does not cover in entirety.
 Of those with Medigap coverage, over 3.9 million people have an AARP Medicare Supplement plan
insured by UnitedHealthcare (for New York residents, UnitedHealthcare Insurance Company of
New York).
– These plans are offered in all 50 states, Washington DC, and various US territories.
 In this study, loneliness, patient satisfaction, and quality of life as well as demographics and health
status were self-reported on the Consumer Assessment of Healthcare Providers and Systems
(CAHPS) survey.
–
–
The CAHPS survey was developed by the Agency for Healthcare Research and Quality, and is
considered the national standard for measuring the experiences of consumers with their health
plans.
Vision problems
Moderate Loneliness
27%
Disengaged from CC program
Severe Loneliness
Depression
 Prevalence of loneliness among survey respondents was high: 28% (N=1,045) were severely
lonely and 27% (N=1,004) were moderately lonely.
 Propensity score modeling was used to adjust for non-response bias, common when conducting
surveys.
 Characteristics associated with having severe loneliness or moderate loneliness vs. not being
lonely were determined utilizing logistic regression models.
 VR-12 QOL physical and mental component scores, i.e. PCS and MCS, associated with severe
loneliness, moderate loneliness, and not being lonely were regression adjusted for demographics,
socioeconomics, and health status.
 The impact of loneliness on patient satisfaction with AARP Medicare Supplement plans, doctors,
and health care was determined adjusted for other confounding variables.
1.00
2.00
3.00
Odds Ratios
Physical Component (PCS) and Mental Component (MCS)
Respondent Demographics
60.0
Not Lonely
Moderate Lonely
Severe Lonely
50.0
Health Status: Fair / Poor
Gender
Not Lonely
Moderate Lonely
Severe Lonely
80%
70%
60%
50%
40%
30%
20%
10%
0%
Male
Female
80%
Not Lonely
Moderate Lonely
Severe Lonely
40%
20%
0%
70-74
75-79
80-84
85+
– Results for moderate loneliness were similar; data not shown.
– Other predictors associated with lower patient satisfaction included older, obese, minority,
and those living in urban areas.
30.0
– Strong predictors of increased patient satisfaction with AARP Medicare Supplement plans
included high health literacy and poor health.
20.0
– Loneliness had a similar impact on patient satisfaction with doctors and health care. (Data
not shown but available.)
Physical Component Score
60%
65-69
32.1
0.0
Depression
Not Lonely
Moderate Lonely
Severe Lonely
33.4
– Few characteristics were protective: only high health literacy and no-deductible plans were
variables indicating a reduced likelihood of loneliness.
10.0
Fair/Poor Health Status
Age Group
40%
35%
30%
25%
20%
15%
10%
5%
0%
Not Lonely
Moderate Lonely
Severe Lonely
35.2
– Other characteristics associated with loneliness included female, older, having trouble with
vision or hearing or problems with walking/balance, and those living in urban areas.
 Severe loneliness was the strongest predictor for dissatisfaction with AARP Medicare
Supplement plans.
42.1
40.0
 The strongest predictor of loneliness was depression.
 Severe and moderate loneliness significantly decreased QOL PCS and MCS scores.
55.2
50.0
70%
60%
50%
40%
30%
20%
10%
0%
4.00
 The strongest predictor of severe loneliness was depression, along with poor health status and
disabilities (i.e., vision, hearing, and walking).
 Almost 55% reported some level of loneliness.
 Loneliness was measured using the UCLA-3 scale with loneliness severity categorized as follows:
a score of 3 as not lonely; 4 or 5 as moderately lonely; and 6 or more as severely lonely.
Statistical Analyses
OR 14.3
CC = Care Coordination
 Overall, 3,765 (27%) of surveyed AARP Medicare Supplement insureds responded.
 Thus, if loneliness were
considered a chronic condition, it
is more prevalent than most
other chronic conditions (e.g.,
obesity, cardiovascular disease,
diabetes, or depression).
Walking problems
Not Lonely
Survey results were collected from individuals in four states (NC, NY, OH, and TX) during 2014
who were 65 years and older, in poor health, and had AARP Medicare Supplement plans.
 QOL was measured using the Veterans Rand 12-item survey (VR-12), a scale validated for older
populations. Patient satisfaction with AARP Medicare Supplement plans, doctors, and health care
was measured on a 10-point scale.
Values greater than 1.0 are
more likely to be very lonely
Female
0.00
Methods
 Almost 55% of the study
population experienced some
level of loneliness.
Engaged in a CC program
Background
 Other studies find that mental health issues among older adults are
often associated with dissatisfaction with healthcare services.
 Overall, among the study
population, 28% were severely
lonely and 27% were moderately
lonely.
Values less than 1.0 are less
likely to be very lonely
First dollar coverage
 To evaluate the impact of loneliness on insureds’ quality of life (QOL) and their satisfaction with
AARP Medicare Supplement plans, providers, and overall health care.
 Research indicates loneliness is associated with depression, poor
health status, disabilities, and decreased QOL.
Conclusions
Depressed
 The lonely were more often female, older, had poorer health status, and depressed.
Mental Component Score
Implications
 Loneliness significantly reduced Physical and Mental quality of life.
Predictors of AARP Medicare Supplement Plan Satisfaction
Severe loneliness
Minority
Obesity
Moderate loneliness
Problems with walking/balance
Risk Score 3rd quartile
First dollar coverage
Middle lower income
Middle upper income
Low income
High health literacy
0.50
0.70
0.90
Values less than 1.0 are less likely to be
satisfied with AARP Medicare Supplement
plans
Values greater than 1.0 are more
likely to be satisfied with AARP
Medicare Supplement plans
1.10
1.30
Odds Ratios
1.50
1.70
1.90
2.10
 The strongest predictor of decreased satisfaction was severe loneliness.
 Predictors of patient satisfaction with doctors and health care were similar (data not shown).
 Screening for loneliness,
especially those with poor
health, may be warranted.
 Loneliness may respond to
interventions, although no
established interventions
have been reported in the
literature.
 UnitedHealthcare and AARP
Services, Inc. (ASI) have
launched a joint pilot
program targeting loneliness
through telephonic health
coaching, community
activities, online support,
and access to gyms.
American Association for Geriatric Psychiatry’s 2015 Annual Meeting—March 27-30, 2015—New Orleans, LA